Complementary and Alternative Medicine Use by Children With Pain in the United States

A large-scale, international cross-sectional survey of published pediatrics authors: Perceptions of complementary, alternative, and integrative medicine

BACKGROUND

The use of complementary, alternative, and integrative medicine (CAIM) is commonly used among pediatric patients for various conditions. Pediatrics clinicians' and researchers' perceptions towards the incorporation of CAIM therapies have varied. This study aims to investigate the perceptions of both pediatrics researchers and clinicians regarding CAIM.

METHODS

We conducted a large-scale, international cross-sectional online survey with published pediatrics authors who have published their work in pediatrics medical journals that are indexed in MEDLINE. In total, 34 494 researchers and clinicians were invited to complete the survey. The survey recorded respondents' perceptions on various CAIM therapies. Descriptive statistics were generated from the quantitative survey results. A thematic analysis was conducted for responses to open ended questions.

RESULTS

In total, 731 pediatrics clinicians and/or researchers responded to the survey, with about half of the respondents being faculty members/principal investigators (56.10 %) and/or clinicians (43.45 %) and from the Americas (46.56 %) or Europe (30.53 %). Over half of the respondents viewed mind-body therapies favourably (62.01 %) and the fewest respondents held favourable perceptions of biofield therapies (6.98 %). Respondents agreed or strongly agreed that there is value in conducting further research on CAIM therapies (85.52 %) and disagreed or strongly disagreed that they felt comfortable recommending most CAIM therapies to patients (64.83 %). A thematic analysis of our findings demonstrates that many pediatrics clinicians and/or researchers support further research on CAIM.

CONCLUSION

The findings from this study demonstrate that pediatrics clinicians and researchers have varying perceptions towards CAIM therapies. Respondents had the most positive perceptions of mind-body therapies and felt they did not have adequate training on CAIM. Further research is needed to establish more evidence-based educational resources on CAIM.

Exploring downstream effects of gender roles in healthcare decision-making and relationships within systems: A cross-sectional analysis of openness to treatment in pediatric headache

OBJECTIVE

Socio-culturally defined identity factors present significant and often understudied influences on the experience, management, and treatment of chronic pain. For instance, there exist societal narratives about how males and females are expected to experience and express pain. Such gender roles may impact youth and caregiver openness to individual multidisciplinary treatments for pediatric headache.

METHODS

In this cross-sectional study, participants (N = 1087 youth/caregiver dyads, Mage = 14.5 years, 71% female, 97% cisgender, 77% White) completed a series of questionnaires, including Openness to Headache Treatment (OHT), upon presenting for initial multidisciplinary evaluation of chronic headache. Pearson correlations, independent samples t-tests and hierarchical regressions were used to analyze potential gender differences in youth and caregiver openness, as well as its relationships with pain-related and psychological factors.

RESULTS

Overall, female youth and their caregivers were more open to headache treatment, broadly and for individual interventions, when compared to male counterparts. Caregiver distress related to their child's headaches (i.e., fear and avoidance) was significantly correlated with openness in female youth and their caregivers, but not males.

CONCLUSION

Gendered patterns in healthcare decision-making in youth and caregivers provide insight on individual, societal, and systemic gender bias.

Association of Neighborhood Characteristics and Chronic Pain in Children and Adolescents in the United States

OBJECTIVE

To determine the associations between neighborhood characteristics and chronic pain during childhood and adolescence in the United States, 2020-2021.

METHODS

Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health. National Survey of Children's Health grouped parents' responses to questions about neighborhood characteristics into 5 categories: neighborhood support, neighborhood safety, school support, neighborhood amenities, and the presence of detracting neighborhood elements. Chronic pain was defined as parents reporting their children had "frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months." Multivariable Poisson regression analyses estimated associations between neighborhood characteristics and chronic pain, adjusted for sociodemographic characteristics.

RESULTS

The sample contained 55,387 children (6 to 17 years), weighted to represent 44 million nationally. Children had significantly increased rates of chronic pain if they lived in neighborhoods that were unsupportive, unsafe, had unsafe schools, fewer amenities, and greater numbers of detracting elements ( P <0.0001). After adjusting for covariates, children had significantly increased chronic pain if they lived in neighborhoods that were not supportive (adjusted prevalence rate ratio=1.7 (95% CI: 1.5-1.9, P <0.0001), with similar patterns observed for living in neighborhoods characterized as not safe, that did not have safe schools, with fewer amenities, and/or more detracting elements.

DISCUSSION

Disadvantageous neighborhood characteristics are associated with pediatric chronic pain prevalence. Future research should investigate the underlying mechanisms of this association and guide neighborhood interventions aimed at preventing and decreasing childhood chronic pain and its associated burdens.

Analysis of the Use of Korean Medicine Treatments among Children and Adolescents in South Korea: Analysis of Nationally Representative Sample

Korean medicine (KM) is pivotal within South Korea's healthcare system. This study aimed to investigate the current use and determinants associated with KM among children and adolescents through an analysis of the 2019 Korea Health Panel Annual Data. Subjects were divided into two groups: the integrative medicine (IM) group, utilizing both KM and conventional medicine (CM) (n = 163), and the CM-only group (n = 1843) for the year 2019. Differences in various factors between the IM and CM groups were investigated using the chi-square test or t-tests. Moreover, binomial logistic regression was employed to ascertain factors influencing the choice of KM over exclusive CM utilization. The IM group had a higher mean age (p = 0.011) and annual household income (p < 0.001) compared to the CM group. The regression analysis indicated a significant association between the use of both KM and CM and being an adolescent (p = 0.011), residing in Seoul/Gyeonggi/Incheon (p = 0.017), living in Daejeon/Chungcheong/Sejong (p = 0.001), and belonging to the first income percentile (p = 0.002). Significant differences were observed in the KM usage patterns between the groups of children and adolescents. These insights could contribute to the development of strategies for the optimal allocation of medical resources within South Korea's distinctive medical framework.

Chronic Pain in Children: Interdisciplinary Management

Chronic pain in children is a relatively prevalent cause of functional disability. Contributing factors to this pain are best viewed through the biopsychosocial model. Although evidence is lacking for individual aspects of treatment, interdisciplinary care is considered the best treatment approach for children with chronic pain. Interdisciplinary care can include medication management with daily and as-needed medications, physical and occupational therapy focusing on function and movement, and psychological treatment with cognitive-behavioral therapy and acceptance focused treatment. In children with severe pain and disability, intensive interdisciplinary pain treatment may be needed to improve pain and function.

Management of Chronic Migraine in Children and Adolescents: Where are We in 2022?

Migraine is a neurological disorder that affects millions of children and adolescents worldwide. Chronic migraine is a subtype of migraine in which patients experience headaches for more days than not each month, with accompanying symptoms of phonophobia, photophobia, nausea or vomiting for most of these headaches. The burden and impact of chronic migraine in the daily lives of children and adolescents is substantial, requiring a holistic, multidisciplinary, and biopsychosocial approach to conceptualization and treatment. The purpose of this review is to provide a comprehensive “2022” overview of acute and preventive treatments for the management of chronic migraine in youth. We first describe diagnostic criteria for chronic migraine and highlight the state of evidence for acute and preventive treatment in children and adolescents. We then discuss emerging treatments currently receiving rigorous clinical research effort, special considerations for the treatment of chronic migraine in children and adolescents, and avenues for improving existing treatments and expanding access to evidence-based care.

Physician Office Visits That Included Complementary Health Approaches in U.S. Adults: 2005-2015

Introduction: The Institute of Medicine has described the need for comparing models of care delivery involving complementary health approaches and conventional medical practitioners. As a step toward addressing this need, we used a nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided. Methods: NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. We examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for health visit. We ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide development of logistic regression models. Results: Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem. Conclusion: We present an overview of the first study of office-based physician visits where complementary health approaches were recommended or ordered to their patients. These data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.

Reasons Office-Based Physicians in the United States Recommend Common Complementary Health Approaches to Patients: An Exploratory Study Using a National Survey

Objective: To examine the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Design: Descriptive estimates of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). Setting/Location: The United States. Outcome measures: Reasons for the recommendation or lack thereof to patients for: herbs and other non-vitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation). Differences by physician sex and medical specialty were described. Results: For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]). For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]). Conclusions: There are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians' decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

Development and Assessment of an Abbreviated Acupuncture Curriculum for Pediatricians

OBJECTIVE

Acupuncture has been shown to improve pain and other health outcomes in children and is well tolerated. However, use of acupuncture by pediatric medical providers is rare, in part due to the cost and time associated with formal training. We aimed to develop an abbreviated acupuncture curriculum and assess its impact and acceptability with academic pediatricians.

METHODS

In this pilot study, pediatricians received instruction in 2 acupuncture protocols for treating acute and chronic pain (Battlefield Acupuncture and Four Gates) during a 10-hour course developed by board-certified medical acupuncturists. Learning methods included an online module with videos and articles, 2 live workshops, and additional home practice. Participants completed a skills-based exam and pre- and post-tests measuring knowledge and attitudes about acupuncture treatment.

RESULTS

Forty-five physicians (divided among 3 cohorts) began the acupuncture training course, and 38 (84.4%) completed all components. The course significantly increased participants' perceived efficacy of acupuncture for acute and chronic pain. Participants showed significant improvement in acupuncture knowledge. All participants agreed that the course would influence their current medical practice, and all participants felt confident utilizing basic acupuncture. Additionally, all participants indicated that they would recommend the abbreviated acupuncture curriculum to a colleague.

CONCLUSIONS

Pediatricians became proficient in 2 acupuncture protocols with a 10-hour curriculum and found the format and content highly acceptable. Future plans include studying acupuncture implementation and expanding the course to other departments and institutions.

Pediatric tuina for allergic rhinitis in children: A systematic review and meta-analysis of randomized controlled trials

AIM

To evaluate the clinical efficacy of pediatric tuina for allergic rhinitis treatment in children.

METHODS

Three English, four Chinese, one Japanese, and two Korean databases were searched for relevant literature published till February 2021, and eligible randomized controlled trials (RCTs) were included for analysis. Data were screened and extracted independently using predesigned forms. The methodological quality evaluation was performed using the tool of Cochrane bias risk assessment, and meta-analysis was performed through Review Manager 5.3.

RESULTS

A total of 12 RCTs, which included 716 children, were selected for meta-analysis. Compared with Chinese herbal medicine, acupuncture, Western medicine, and other therapies, pediatric tuina alone or in combination with other treatments had a higher clinical effectiveness (relative risk = 1.16, 95% confidence interval [CI] = 1.08-1.25) in treating children with allergic rhinitis. Pediatric tuina also effectively improved the following signs and symptoms of allergic rhinitis in children: nasal congestion (mean difference [MD] = -0.44, 95% CI = -0.70 to -0.19), runny nose (MD = -0.39, 95% CI = -0.55 to -0.23), sneezing (MD = -0.23, 95% CI = -0.38 to -0.08), and turbinate swelling (MD = -0.26, 95% CI = -0.48 to -0.04); all differences were statistically significant.

CONCLUSIONS

The present study provided favorable evidence for the treatment of allergic rhinitis in children with pediatric tuina. However, owing to the impact of research quality, this evidence needs to be validated via strictly designed clinical trials.

Psychological Interventions for Pediatric Headache Disorders: A 2021 Update on Research Progress and Needs

PURPOSE OF REVIEW

This review summarizes key findings from recent investigations of psychological interventions for pediatric headache disorders and discusses important avenues for future research.

RECENT FINDINGS

Cognitive Behavioral Therapy (CBT) is effective in reducing headache days among youth with chronic headache. There is mixed evidence for the benefit of CBT on reducing disability associated with migraine, suggesting that there is room to optimize CBT by leveraging complementary or alternative psychological interventions, such as Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches. Tailoring CBT may be especially important for youth with more impairing or complex clinical presentations, such as those with continuous headache. Using eHealth and novel study designs to expand access to and dissemination of psychological interventions is promising. Although CBT is the gold standard psychological treatment for youth with migraine, we are only beginning to understand how and why it is effective. Other promising psychological treatments are available, and studies are beginning to examine how CBT can be optimized to fit the unique needs of each patient. Improving access and equitability of care for youth with migraine will require tailoring psychological treatments for patients with varying headache presentations and youth from a variety of cultural, racial, ethnic, and linguistic backgrounds.

Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary

Naturopathic medicine is a growing profession in North America that provides expertise in complementary and alternative, or integrative care to pediatric patients. It is imperative that healthcare providers have an understanding of the training and scope of other health professionals in order to effectively make decisions regarding research, collaborative clinical care, and policy. Given the prevalence of use of complementary and alternative medicine by children and families in North America, and the growing interest in "integrative" medicine, we aim to offer an overview of naturopathic care for children. This document describes the principles, training, and scope of naturopathic medicine, including health promotion, disease prevention, and illness management. It describes the process by which naturopathic doctors create an integrative healthcare plan for children, evaluate and apply evidence, and integrate ethical issues in practice management, and speaks to the role naturopathic doctors have regarding advocacy for community and planetary health as it relates to pediatrics.

Martial Arts-Based Therapy Reduces Pain and Distress Among Children with Chronic Health Conditions and Their Siblings

Objective

Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings.

Methods

This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5–17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques.

Results

Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5–17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath Brake^TM or other martial arts techniques) outside of class, such as at home.

Conclusion

Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.

Factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda Northwest Ethiopia: A cross-sectional study

Background:

Over the last 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care in most parts of the world. However, large sections of the population in developing countries still depend on traditional medicines for their primary health care needs. More than 88% of Ethiopian parents use different forms of traditional medicine for their children. Therefore, this study aimed to determine factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda.

Method:

Community-based cross-sectional study was conducted from 1 to 30 March 2019 in Fagita Lekoma Woreda. Data collection tool was a structured interviewer-administered questionnaire. Both descriptive and inferential statistics were used to present the data. Odds ratio and binary and multiple logistic regression analysis were used to measure the relationship between dependent and independent variables.

Results:

Among 858 participants, 71% of parents had used traditional medicine for their children within the last 12 months. Parents who cannot read and write (adjusted odds ratio = 6.42, 95% confidence interval = 2.1–19.7), parents with low monthly income (adjusted odds ratio = 4.38, 95% confidence interval = 1.58–12.1), and those who had accesses to traditional medicine (adjusted odds ratio = 2.21, 95% confidence interval = 1.23–3.98) were more likely to use traditional medicine for their children. Urban residents (adjusted odds ratio = 0.20, 95% confidence interval = 0.11–0.38) and members of community-based health insurance (adjusted odds ratio = 0.421, 95% confidence interval = 0.211–0.84) were less likely to use traditional medicine for their children.

Conclusions:

Our study revealed that the prevalence of traditional medicine remains high. Educational status, monthly income, residence, accessibility to traditional medicine, and being a member of community-based health insurance were predictors of potential traditional medicine use. Therefore, the integration of traditional medicine with modern medicine should be strengthened. Community education and further study on efficacy and safety of traditional medicines should be also given great attention.

School Absence Associated With Childhood Pain in the United States

OBJECTIVE

The objective of this study was to estimate the national burden of school absenteeism associated with pain among 6 to 17-year-old children in the United States.

METHODS

Data were analyzed from a large, nationally representative sample from the 2012 National Health Interview Survey. Associations between pain and school absence were analyzed using multivariate negative binomial models controlling for sociodemographic and clinical characteristics.

RESULTS

The sample contained 8641 participants, of whom 30.3% reported pain over the preceding 12 months. Mean number of parent-reported school days missed across the entire sample was 3 per child; however pain was associated with an additional 1.5 reported missed school days per child. Furthermore, pain was associated with higher rates of chronic absenteeism (missing >15 d of school): 6.1% of children with pain was chronically absent as compared with 1.3% of children without pain. Extrapolated to the nation, childhood pain in the United States was associated with 22.2 million additional days of missed school, whereas childhood asthma, in comparison, was associated with 8 million additional days of school missed.

DISCUSSION

Associations between pain and school absenteeism highlight the need for interventions aimed at improving school attendance among children with pain.

Perceptions Regarding Daith Piercing in Migraine, A Survey of Pediatric Patients

The treatment of migraine is evolving to include non-traditional approaches, as pharmacologic therapy alone is unsuccessful in many patients. Daith piercing, a cartilaginous ear piercing, has become popular as a potential nonpharmacological treatment option for migraine. However, there are no systematic data on the utilization and efficacy of these piercings. Therefore, we investigated the perceptions of pediatric patients regarding Daith piercing and gathered initial retrospective data for patients who had already received it. Patients presenting to a pediatric neurology clinic were invited to complete a questionnaire to assess knowledge about and attitudes towards Daith piercing and their willingness to undergo such a treatment. For those with a Daith piercing, the effects on headaches, function, and mood were evaluated. Of the 171 respondents, 61% had prior knowledge of Daith piercings, 27% knew someone with a Daith piercing, and 60% of patients presenting with headache were willing to undergo piercing. Of the eight patients (5% of respondents) who had already undergone piercing, six (75%) reported improvement in headaches, five (62%) had missed fewer days of school or work, and seven (87%) reported mood improvement. The high proportion of pediatric patients willing to undergo this form of treatment speaks to the desire for and acceptance of nonpharmacologic treatments. Although based on a small sample, the data from children who have already undergone Daith piercing is promising and supports a need for further systematic investigation into this treatment approach.

Food Habits, Stressors, and Use of Complementary Medicine Therapies Among Pediatric Patients Who Attend an Integrative Medicine Pediatric Pain Clinic

Purpose: Chronic pain is a growing problem among children and adolescents, and is more prevalent in low-income families. This observational study was conducted to describe the demographics and various descriptors, complementary medicine therapy (CMT) use, and lifestyle factors (i.e., food habits and supplement use) of pediatric patients with chronic pain. Methods: Boston Medical Center's Interdisciplinary Pediatric Pain Clinic provides patient education and unique treatment plans, tailored with medical and nonpharmacologic interventions for managing complex and chronic pain. Patient data were obtained through electronic medical chart review and self-reported surveys, and were completed by participants and parents at enrollment. Results: Of the 83 participants, the average age was 15.4 ± 4.3, and 80% were female. Referrals to the clinic were due to abdominal pain (52%), headache (23%), and musculoskeletal or other pain (25%). Thirty-one percent were on food assistance programs, with only 24% of patients currently using CMTs and 85% using pain medications. More than half of all participants (63%) missed up to 5 days of school in the past year, while 26% missed more than 6 days. School or academics (77%) were the most frequently self-reported stressor, followed by social/peer issues (39%), bullying (18%), and parental stress (18%). A very small proportion of patients had sufficient intake of dairy (12%), water (23%), vegetables (1%), and fruits (22%). Conclusion: Chronic pain can significantly affect lifestyle factors, stress, and child development. Patients evaluated at the clinic had poor diets and report having stressors regarding school, social/peer issues, parental stress, and bullying.

A Secondary Analysis of Integrated Pediatric Chronic Pain Services Related to Cost Savings

Youth with chronic pain have high healthcare utilization and associated costs. Research supports integrated treatment; though, it's unclear which treatments are used and cost-effective. This study expands on work that found reduced service use and cost savings following participation in an outpatient integrated pediatric pain clinic. We explored which services were commonly used and which individual (psychotherapy, medication management, acupuncture, massage, biofeedback) and/or combinations of services were associated with service use reduction and cost savings. Medication management and psychotherapy were more common than complementary integrative medicine (CIM) services. Massage services were associated with reduced inpatient costs. There were trends of fewer emergency department visits for participants who received CIM services in addition to medication management and psychotherapy, and more visits for those with biofeedback. Findings suggest that a more detailed examination of service utilization is needed to better understand cost outcomes related to the integrated treatment of pediatric chronic pain.

"I Could Feel It!": A Qualitative Study on How Users of Complementary Medicine Experience and Form Knowledge About Treatments

Purpose: The aim of this study was to examine how users of complementary and alternative medicine (CAM) experience various forms of treatments, form knowledge about them, and understand the boundaries between CAM and conventional health care. Method: Semistructured qualitative interviews, with 10 CAM users in Sweden, analyzed with qualitative content analysis and quantitative network analysis, and subsequent network visualizations. Findings and Conclusion: The main findings stressed the importance to CAM users of bodies and physical experiences, both in experiencing and forming knowledge about treatments. Physical experience was often contrasted with theoretical understanding. Another key finding was that the CAM users seemed to set up different standards for conventional and public health care and CAM. Although scientific explanations were considered as generally important for legitimacy, and conventional health care was expected to be evidence based, they were less important to personal use and in the use of CAM. In these cases, firsthand experience of positive effects were decisive.

Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital

BACKGROUND

Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography.

METHODS

An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected.

FINDINGS

Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking.

CONCLUSION

Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.

Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey

OBJECTIVE

The purpose of this study was to describe the prevalence of chiropractic utilization and examine sociodemographic characteristics associated with utilization in a representative sample of US children and adolescents aged 4 to 17 years.

METHODS

Data are from 9734 respondents to the 2012 National Health Interview Survey. Age, sex, race/ethnicity, geography, family income, parental educational attainment, and other health care providers served as exposure variables. Chiropractic utilization in the past 12 months (yes/no) was the targeted outcome. Weighted crude and adjusted logistic regression models, controlling for relevant covariates, were performed.

RESULTS

The 12-month prevalence of chiropractic utilization in US children was 3.0% (95% confidence interval: 2.6%-3.6%). The adjusted odds (95% confidence interval) of chiropractic utilization were higher among 11- to 17-year-olds (2.02 [1.41-2.90]) (vs 4- to10-year-olds), Midwest residents (2.45 [1.36-4.44]) (vs Northeast), families with incomes ≥$100000 (3.25 [1.87-5.66]) (vs <$35000), and those that visited other Complementary and Integrative Health (also known as Complementary and Alternative Medicine) practitioners (11.26 [7.19-17.64]). Blacks and Asians had lower adjusted odds of chiropractic utilization compared with whites (0.17 [0.06-0.47] and 0.17 [0.07-0.43], respectively). Sex, parental education, and having an orthodox medical personal physician were not associated with utilization.

CONCLUSION

Although overall prevalence was low, sociodemographic characteristics of child and adolescent users of chiropractic care were identified. Age, race/ethnicity, region of residence, family income, and utilization of other Complementary and Integrative Health services were associated with chiropractic utilization, after adjusting for sociodemographic covariates.

Chronic opioid use and clinical outcomes in lung transplant recipients: A single-center cohort study

INTRODUCTION

Chronic opioid use is common after organ transplantation, and has been associated with poor outcomes in transplantation of abdominal organs. However, little is known about possible influences of chronic opioid use on outcomes of lung transplantation (LTx).

OBJECTIVES

We assessed whether long-term chronic opioid use influenced clinical outcomes among LTx recipients at our program.

METHODS

We retrospectively evaluated chronic opioid use among bilateral LTx recipients ages 12 and older followed at our institution 1-5 years post-transplant. Chronic opioid use was defined as ≥3 months of consecutive prescribed use. Outcomes included survival, hospitalization, emergency department and urgent care visits, forced expiratory volume in one second (FEV1), and allograft rejection.

RESULTS

Twenty-one patients ages 15-50 years met inclusion criteria. On multivariable analysis, initiation of chronic opioid use was followed by increased mortality hazard (hazard ratio=7.1; 95% confidence interval [CI]: 1.1, 45.0, P = 0.037) and decreased FEV1 (-16%; 95% CI: -24%, -7%; P < 0.001), although no differences were observed in risk of acute care visits, inpatient admission, or chronic rejection.

CONCLUSION

This analysis presents the first evidence that late-onset chronic opioid use may be associated with decreased lung function and increased mortality after LTx. Therefore, evaluation of chronic opioid use should be included in the routine monitoring of transplant recipients, to better define the impact of this risk factor on LTx outcomes.

Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting-Concept and Realization

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children’s hospital can be successful.

The Evidence for the Role of Nutraceuticals in the Management of Pediatric Migraine: a Review

PURPOSE OF REVIEW

Nutraceuticals are a form of complementary and alternative medicine that is commonly used by children and adolescents with migraine. In this review, observational studies, randomized controlled trials, systematic reviews, and meta-analyses on the efficacy and safety of single compound nutraceuticals for the management of migraine in children and adolescents were identified through a literature search of MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials.

RECENT FINDINGS

Twenty-one studies were reviewed, of which 11 were observational studies, 7 were randomized controlled trials, and 3 were systematic reviews. Six different nutraceuticals were included in the review: vitamin D, riboflavin, coenzyme Q10, magnesium, butterbur, and polyunsaturated fatty acids. All but three of the studies assessed the role of nutraceuticals in migraine prevention, while three studies evaluated the role of intravenous magnesium for acute migraine management. Overall, the quality and size of the studies were limited. Due to low quality evidence and limited studies, no definite conclusions can be drawn on the efficacy of nutraceuticals for the treatment of pediatric migraine. Future studies are warranted in order to establish evidence upon which to define the role of nutraceuticals in this patient population.

Health Care Utilization and Costs Associated With Pediatric Chronic Pain

The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.62-2.47; P < .001), complementary and alternative medicine (OR = 2.32, 95% CI = 1.79-3.03; P < .001), and emergency care (OR = 1.62, 95% CI = 1.29-2.02; P < .001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use.

PERSPECTIVE

Among children with chronic pain, we show high rates of use of emergency care but limited use of mental health care, which may suggest opportunities to increase multidisciplinary treatment of chronic pain.

Caregivers' knowledge and acceptance of complementary and alternative medicine in a tertiary care pediatric hospital

Background

The use of complementary and alternative medicine (CAM) therapies has increased in children, especially in those with chronic health conditions. However, this increase may not translate into acceptance of CAM in the perioperative setting. We surveyed caregivers of patients undergoing surgery to determine their knowledge and acceptance of hypnotherapy, acupuncture, and music therapy as alternatives to standard medication in the perioperative period.

Materials and methods

An anonymous, 12-question survey was administered to caregivers of children undergoing procedures under general anesthesia. Caregivers reported their knowledge about hypnotherapy, music therapy, and acupuncture and interest in one of these methods during the perioperative period. CAM acceptance was defined as interest in one or more CAM methods.

Results

Data from 164 caregivers were analyzed. The majority of caregivers were 20-40 years of age (68%) and mothers of the patient (82%). Caregivers were most familiar with acupuncture (70%), followed by music therapy (60%) and hypnotherapy (38%). Overall CAM acceptance was 51%. The acceptance of specific CAM modalities was highest for music therapy (50%), followed by hypnotherapy (17%) and acupuncture (13%). In multivariable logistic regression, familiarity with music therapy was associated with greater odds of CAM acceptance (odds ratio=3.36; 95% CI: 1.46, 7.74; P=0.004).

Conclusion

Overall CAM acceptance among caregivers of children undergoing surgery was 51%, with music therapy being the most accepted CAM method. Familiarity with music therapy was the only factor that was independently associated with accepting CAM in the perioperative period. The low acceptance for acupuncture and hypnosis in the perioperative situation may be related to insufficient parental knowledge and information.

Factors associated with insomnia and complementary medicine use in children: results of a national survey

OBJECTIVES

Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping.

METHODS

We used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6-17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use.

RESULTS

6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001).

CONCLUSIONS

CAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.

Comparison of pediatric self reports and parent proxy reports utilizing PROMIS: Results from a chiropractic practice-based research network

OBJECTIVE

To measure the cross-informant variant of pediatric quality of life (QoL) based on self-reports and parent proxy measures.

METHODS

A secondary analysis of baseline data obtained from two independent studies measuring the QoL based on the pediatric PROMIS-25 self-report and the PROMIS parent-proxy items banks. A scoring manual associated raw scores to a T score metric (mean = 50; SD = 10). Reliability of QoL ratings utilized the ICC while comparison of mean T Scores utilized the unpaired t-test.

RESULTS

A total of 289 parent-child dyads comprised our study responders. Average age for parents and children was 41.27 years and 12.52 years, respectively. The mean T score (child self-report: parent proxy) for each QoL domains were: mobility (50.82:52.58), anxiety (46.73:44.21), depression (45.18:43.60), fatigue (45.59:43.92), peer-relationships (52.15:52.88) and pain interference (47.47:44.80).

CONCLUSION

Parents tend to over-estimate their child's QoL based on measures of anxiety, depression, fatigue, peer-relationships and pain interference.